Sudomotor dysfunction is associated with foot ulceration in diabetes

Area of Science:

• Diabetology
• Neurology
• Autonomic Nervous System Research

Background:

• Diabetic foot ulceration (FU) is a major complication of diabetes.
• Peripheral sensorimotor neuropathy (PN) is a known risk factor for FU.
• The role of sudomotor dysfunction in FU development requires further investigation.

Purpose of the Study:

• To investigate the association between sudomotor dysfunction and the presence of foot ulceration in patients with diabetes.
• To assess the utility of sudomotor function tests in identifying diabetic patients at risk for foot ulcers.

Main Methods:

• A cross-sectional study involving 90 patients with Type 1 or Type 2 diabetes, categorized into groups with no neuropathy, neuropathy without FU, and neuropathy with FU.
• Peripheral sensorimotor neuropathy assessed using Neuropathy Symptom Score (NSS), Neuropathy Disability Score (NDS), and Vibration Perception Threshold (VPT).
• Sudomotor function evaluated via Sympathetic Skin Response (SSR); cardiac autonomic function also assessed.

Main Results:

• Patients with FU exhibited longer diabetes duration, higher NDS and VPT, and poorer autonomic function test results compared to other groups.
• Sudomotor dysfunction and cardiac autonomic neuropathy were more prevalent in the FU group.
• Absent SSR (OR 15.3), high NDS (OR 10.2), and high VPT (OR 19.8) were independently associated with increased odds of FU after adjusting for covariates.

Conclusions:

• Sudomotor dysfunction is significantly linked to an elevated risk of developing foot ulcers in diabetic individuals.
• Incorporating sudomotor function assessment into routine screening can help identify diabetic patients at high risk for foot ulceration.